Glioblastoma Multiforme'nin Tedavi Sonrası Psödoprogresyon ile Progresyon Ayrımı: Seri Perfüzyon MR Görüntülemelerde rCBV ve rCBF Değerlerinde Azalma Oranının Yararı

Year 2023, , 15 - 21, 30.03.2023

Olgun Şahin , Hilal Şahin , Mehmet Cem Çallı

https://doi.org/10.57221/izmirtip.1252962

Abstract

Amaç: Radyoterapi (RT) ve Temozolomid (TMZ) tedavisi alan glioblastoma multiforme (GBM) hastalarında erken psödoprogresyonun gerçek progresyondan ayrımında perfüzyon manyetik rezonans görüntülemenin (pMRG) değerinin değerlendirilmesi. Gereç ve Yöntemler: Radyoterapi ve Temozolomid tedavisi alan ve RT öncesi ve sonrası kranial pMRG tetkikleri olan 23 hasta değerlendirildi. Rölatif serebral kan hacmi (rCBV) ve rölatif serebral kan akımı (rCBF) seri MRG tetkikleri ile değerlendirilerek oranlandı. rCBV ve rCBF değerlerinde azalma oranı eşik değerinin belirlenmesi için receiver operating characteristic (ROC) analizi uygulandı. Bulgular: Dokuz (%39) hastada radyolojik progresyon bulguları saptandı. Bu hastalar takip MRG tetkikleri, klinik parametreler ve/veya patolojik bulgular ile birlikte değerlendirildiğinde altısı (%67) gerçek progresyon iken, üçü (%33) psödoprogresyon olarak saptandı. Psödoprogresyon grubunda rCBV ve rCBF azalma oranları sırasıyla 2.928 ve 2.510 olup Mann-Whitney U testine göre fark anlamlı idi (p=0.02). RT öncesi ve sonrası pMRG tetkiklerinde saptanan rCBV ve rCBF azalma oranı eşik değerleri (sırasıyla 1.73 ve 1.62) erken psödoprogresyonu ayırt etmede %100 duyarlı ve %100 özgül olarak bulundu. Sonuç: Radyoterapi ve Temozolomid tedavisi alan GBM hastalarında rCBV ve rCBF azalma oranı erken psödoprogresyonun güvenilir bir göstergesidir.

Keywords

perfüzyon, manyetik rezonans görüntüleme, glioblastoma multiforme, psödoprogresyon, radyoterapi

Supporting Institution

yok

Project Number

yok

Distinction of Pseudoprogression and Progression in Glioblastoma Multiforme After Treatment: Utility of Ratio of Decrease in rCBV and rCBF Values on Serial Perfusion MRIs

Abstract

Aim: To assess the value of perfusion magnetic resonance imaging (pMRI) in the differentiation of early pseudoprogression from true progression in glioblastoma multiforme (GBM) patients taking Temozolomide (TMZ) with radiotherapy (RT) treatment. Materials and Methods: Pre-RT and post-RT cranial pMRI scans of 23 GBM patients treated with RT-TMZ were reviewed. Relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) of the residual enhancing lesions were measured on serial pMRI scans and proportioned. Receiver operating characteristic (ROC) analysis was performed to determine a threshold ratio of decrease in rCBV and rCBF. Results: There were nine patients (39%) with signs of radiological progression, of whom six (67%) had real progression and three (33%) had pseudoprogression based on follow-up MRI studies, clinical parameters and/or pathology. Ratio of decrease was 2.928 in rCBV and 2.510 in rCBF in the pseudoprogression group, which were significant according to Mann-Whitney U test (p=0.02). Cut-off ratio of decrease value of 1.73 for rCBV and 1.62 for rCBF between pre-RT and post-RT pMRI study, could differentiate the presence of early pseudoprogression with 100% sensitivity and 100% specificity.
Conclusion: Ratio of decrease in rCBV and rCBF is a reliable predictor of early pseudoprogression in GBM patients under RT-TMZ treatment.

Keywords

perfusion, magnetic resonance imaging, glioblastoma multiforme, pseudoprogression, radiotherapy

Project Number

yok

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